MIRA NITIN DVIVEDI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064054

License Status

EXPIRED

Business

First Name

MIRA

Middle

NITIN

Last Name

DVIVEDI

Suffix

Business Name

MIRA NITIN DVIVEDI MD

Original Issue Date

07/01/2013

Effective Date

07/01/2013

Expiration Date

06/30/2016

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

08/16/2016